1. Acknowledgements RHH ED staff Safety and Quality Unit RHH for their participation and valuable contribution Next Steps It is envisaged over the next 12 months that the implementation of hospital wide changes will ultimately enhance the delivery of safe and efficient patient centered care and further work to achieve National Emergency Access Targets. Introduction Emergency Department (ED) overcrowding and issues related to flow into, through and out of the ED are not new to EDs. EDs have reached a crisis point as emergency staff are challenged in caring for unwell patients in a timely manner. The focus of ED overcrowding has remained on EDs, and many departments have implemented a range of strategies to overcome this. It is well documented that access block leads to ED overcrowding resulting an increased in-hospital mortality, increased inpatient length of stay, delays in definitive emergency therapy and patient dissatisfaction. In 2012 the Royal Hobart Hospital (RHH) ED introduced a system of Team Based Care and Streaming of patients into Admission and Discharge Streams to improve patient outcomes and patient flow through the ED. The National Health Reform Agreement – National Partnership Agreement on Improving Public Hospital Services was developed to improve public patient access to EDs and elective surgery by improving capacity and efficiency in public hospitals. The National Emergency Access Targets (NEAT) were introduced with 90% of all patients presenting to the Emergency Department to be admitted to hospital or discharged home within 4 hours of their presentation by 2015. The benchmark targets are to be implemented over the next four years (see table below). Average NEAT benchmark targets for Tasmania Introduction Emergency Department (ED) overcrowding and issues related to flow into, through and out of the ED are not new to EDs. EDs have reached a crisis point as emergency staff are challenged in caring for unwell patients in a timely manner. The focus of ED overcrowding has remained on EDs, and many departments have implemented a range of strategies to overcome this. It is well documented that access block leads to ED overcrowding resulting an increased in-hospital mortality, increased inpatient length of stay, delays in definitive emergency therapy and patient dissatisfaction. In 2012 the Royal Hobart Hospital (RHH) ED introduced a system of Team Based Care and Streaming of patients into Admission and Discharge Streams to improve patient outcomes and patient flow through the ED. The National Health Reform Agreement – National Partnership Agreement on Improving Public Hospital Services was developed to improve public patient access to EDs and elective surgery by improving capacity and efficiency in public hospitals. The National Emergency Access Targets (NEAT) were introduced with 90% of all patients presenting to the Emergency Department to be admitted to hospital or discharged home within 4 hours of their presentation by 2015. The benchmark targets are to be implemented over the next four years (see table below). Average NEAT benchmark targets for Tasmania Patient Presentations Over the past 5 years the RHH has seen an increase in the number of patients presenting for treatment. Staff Survey Whilst being able to analyse the effects on patient flow and waiting times statistically, it is also important to evaluate the other components of In order to gain the ED staff perspective a staff survey was undertaken in August/September 2012. The Introduction of Teams and Streams Emergency Department Royal Hobart Hospital Aim The Introduction of a new model of care (Teams and Streams) is an ED strategy to improve the delivery of patient care in a safe efficient and timely fashion. This assists the ED to achieve the NEAT. The Introduction of a Team and Stream Model provides consistency in care, early decision making for disposition with a team-based approach. Objectives 1.Improve the coordination and timeliness of patient care in ED 2.Improve the care planning and coordination of patients in ED 3.Improve the patient experience and satisfaction 4.Increase the percentage of patients leaving the ED in 4 hours Streaming The Streaming of patients into likely admission and likely discharge by the triage nurse has been found to be a strategy of variable benefit. Admission and discharge streaming is easily measured and quality controlled as the Streaming preference is entered onto the Emergency Department Information System at triage. Teaming Team assignment is based on a geographical areas within the ED. Each Team consists of medical and nursing staff with a Team Leader in each Team. This improves communication and coordination of patient care providing the patient with a consist approach to their care. The care of patients presenting to ED is shared with an ED multi disciplinary team, with a coordinated approach to the patients physical, social and psychological issues being provided. Geographical ED Map of Streaming and Teaming Areas Percentage of presentations seen within time, by triage, by year Total number of RHH ED patient presentations Time to Patient Treatment The triage nurse provides a brief clinical assessment that determines the urgency of treatment and the time and sequence in which patients should be seen. The introduction of Streaming and Teaming has resulted in an increasing the initiation of treatment within the recommended time. 1 JAN 2012 TO 31 Dec 2012 (Period 1)72% 1 JAN 2013 TO 31 Dec 2013 (Period 1)78% 1 JAN 2014 TO 31 Dec 2014 (Period 1)84% 1 JAN 2015 TO 31 Dec 2015 (Period 1)90% This has resulted in less patients leaving the ED before seeing a doctor